Wednesday, August 26, 2009

Health Care and RIP Ted

It's the morning after publishing this post and I just learned of the passing of Senator Ted Kennedy. Because of his commitment to health care for all, I think it's more important than ever that we pass the best health insurance reform we can.

This one goes under the heading of WTF.

Because of the rising costs of premiums, my employer has decided to switch health insurance carriers. Because I live in Massachusetts where insurance companies aren't allowed to discriminate based on pre-existing conditions, I wasn't worried about my MS treatment being covered.

But this is insurance we're talking about.

To help us with the transition, we had an information session with HR and representatives from the new insurance company. Just before the meeting, I learned that my boss was a little pissed off that he would still have to pay a $150 co-pay for an MRI. "Still?" I inquired since I've had several MRIs since I began working there and I haven't paid anything for a co-pay. We both assumed it was because his MRI was ordered after an injury and mine were used to determine my course of treatment for MS.

During the question and answer period of the information session, I raised my hand and asked the insurance rep if they waived the MRO co-pay for people with a diagnosed neurological condition...say...Multiple Sclerosis?

The rep told me she would check and let the HR department know the answer.

Well, today I got the answer and here it is, directly cut and pasted from an email from the insurance company:

Q - Would we exclude the MRI HTI copayment for members with a multiple sclerosis diagnosis?
The only exception listed is for members with a current cancer diagnosis. Each and every claim must be billed with the cancer diagnosis in order for the HTI copay to be waived. The copayment would apply in all other circumstances.

The good news is that my boss is taking this to a higher level--more evidence that I work for a compassionate organization and not an evil insurance company.

This recent event made the following video and the ongoing health insurance reform debate even more relevant to me as a person with MS. I sincerely hope that Congress has the good sense to keep the public health insurance option.


  1. I have a medicare advantage plan with Aetna and my copays for MRI are $500 limited to one per year per body region.

    Isn't that ridiculous?

    As soon as open enrollment comes up in November, I am going to switch back to my husband's plan, even though it is $300 more in premiums per month. I pay $109 now for medical, dental, labs, prescriptions, and diagnostic testing - all with copays from $30 to $1000 (surgical procedures in office). This insurance was good for me to have for one year because I know I don't need any MRI's until next February. Most of my surgeries are elective and I am scheduling brain surgery for next June. Labs cost $30 per visit (no matter what they draw). ER is $50. Dental is $10/visit and no higher than $40 per service.

    So you might see how I was attracted to the $109 premium. Hubby's extra for me to be added on is $410 a month. We needed this one year break to give our finances a break.

    I am still amazed at how much people pay for health care insurance and what it does and doesn't cover. Medicare Advantage programs are cheap but they do not allow you to have other insurance along with them unless that one becomes your primary. I didn't want to pay for two insurances.

    I have looked into AARP (since I am over 55) and joined for 3 years. Their drug plan is decent, but no dental, which I don't use often but it's nice to have it.

    I hope you get your insurance straightened out with the new offerings and I know you will do your homework as usual.


  2. please add my blogs to your sidebar:



  3. Anne, what's the brain surgery for? Also consider that one MRI with a $500 copay only increases your costs by $42 each month. If you like the Medicare Advantage plan otherwise, consider that you could have 7 MRIs during the year and come out equal in overall cost.

    My insurance:
    Premiums - $431 (for an underwritten policy)
    MRI copay - $550 (plus fee for radiologist)
    Dr visit copay - $25
    Blood Work - 10% coinsurance
    IVSM - $25 copay/day and 10% coinsurance
    ER visit - $100 copay
    Drug coverage - capped at $1500 each year

    Sorry, $150 for MRI copay is so totally reasonable. Tell your boss that.

  4. Anne,
    I added your blog to my roll of MS bloggers. I had to laugh when I read that you are having elective brain surgery. :-)
    It's very difficult to have to make so many choices with coverage etc. factoring in the MS.
    I have to disagree with you that $150 is reasonable. I saw a clip of Senator Kennedy yesterday talking about how, when his son had cancer, he realized that his Congressional insurance covered things that his son needed but that he knew there were other parents who did not have the same coverage for treatment/tests that their sick chicken needed. I suspect, if there is a member of congress with MS, they don't pay $150 copay for an MRI.
    Lazy J

  5. Hi Julie,
    I looked up FEBHP (which I believe members of Congress are considered federal employees) and found the following regarding minimum benefit requirements for health insurance plans, regarding MRIs.

    Under the Standard Option -
    Preferred - 15% coinsurance
    Participating - 30% coinsurance
    Non-participating - 30% coinsurance plus the difference between allowed rate and billed rate

    Under the Basic Option -
    Preferred - Nothing
    Participating/Non-participating - All charges

    Then I compared four different, real-life insurance offerings available to federal employees here in Northern Virginia. The copays for MRIs ranged from $30 to $75.

    I would not wish to pay 15% for MRIs and 30% sounds impossible to me. This is one thing which I'm thankful for. When I purchased health insurance 9 years ago, I chose the very best coverage available to me which has only a 10% coinsurance requirement.

    $550 out-of-pocket for MRIs is so much better than $875 or $1750 (yikes!!)